Supporting Statement Part B 4-21-2008

SUPPORTING STATEMENT

Part B

Technical Assistance for Health IT and Health Information Exchange in Medicaid and SCHIP

Version April 14, 2008

Agency of Healthcare Research and Quality (AHRQ)

Table of contents

B. Collections of Information Employing Statistical Methods 3

1. Respondent universe and sampling methods 3

2. Information Collection Procedures 3

3. Methods to Maximize Response Rates 4

4. Tests of Procedures 5

5. Statistical Consultants 6

B. Collections of Information Employing Statistical Methods

1. Respondent universe and sampling methods

We will solicit participation from the Medicaid and SCHIP agencies in all 56 states and territories, including the District of Columbia, to participate in the needs assessment. We expect an average of 30 agencies to participate in the needs assessment each year. Agencies that refuse initially will be re-contacted and offered the opportunity to participate in the needs assessment the following year.

2. Information Collection Procedures

The needs assessment will be conducted as a semi-structured interview guided by a series of questions that ask Agency staff about the need for technical assistance to assist Agencies to adopt and implement their Health IT programs and HIE activities (attachment C). We will schedule needs assessment interviews and site visits on a flow basis, as agencies agree to participate. The interviews will be conducted either in-person at the Agency or by Webex and teleconference. The interviews will be conducted by 2 project staff. One will be a professional interviewer and the other will serve as the recorder who will capture the information into the instrument on a laptop. Since the expertise or knowledge of Agency Health IT and HIE activities may be the domain of multiple people within the agency, we anticipate that multiple staff will contribute responses to the questions. When scheduling interviews, we will go over an agenda with the director (or his/her designate), determine the personnel best able to provide information on key topic areas (e.g., business functions), and include meetings with each staff member and key stakeholder.

Prior to the interviews, we will pre-populate the interview guides with whatever relevant information has been collected during the document review and state profile sub-tasks. The team will use the assessment instrument’s semi-structured interview to validate the pre-populated information and obtain additional/new information about the status of health IT and HIE within the agencies, any on-going projects or initiatives, notable strengths or expertise, challenges (including barriers), priority areas of concern, and need for consultative and technical assistance within the scope of the project. Probes/examples of specific areas of technical assistance available will be included. The team will collect as much information about the details of the assistance being requested during the interviews and will note any follow-up information needs. Data will be captured electronically, with both closed and open-ended response categories.

To facilitate the analysis, storage, and retrieval of information collected from the needs assessment interviews and to inform the prioritization and planning of the consultative and technical assistance, project staff will develop a database that can be used for coding of open-ended responses, data analysis, and report generation.

3. Methods to Maximize Response Rates

It is best practice in survey methodology to make repeated contacts with the target population to maximize response rates. First we will send a packet of materials introducing the project to all Medicaid and SCHIP Agency Directors. A current list of all Medicaid and SCHIP Directors will be obtained from the National Association of State Medicaid Directors (NASMD). Project information packets will be mailed directly to them by Federal Express. The information packet will include:

• A cover letter from AHRQ introducing the project (Attachment F1)

• A cover letter from AHRQ contractor (Attachment F2)

• An endorsement letter from NASMD (Attachment F3)

• A one-page “Project Fast Facts” description of the project (Attachment F4)

• A Resource list of publicly available resources for implementing health IT and HIE systems (Attachment F5)

• A fact sheet describing the needs assessment topics (Attachment F6)

The package announcing the project will be sent in March 2008 to make the agencies aware of the project and the availability of some types of technical assistance that will be available during the first year of the project prior to the conduct of the needs assessment.

Prior to conducting the needs assessment, a second package of materials will be sent to the Medicaid and SCHIP Directors via Federal Express announcing the needs assessment. The second mailing will inform the Medicaid and SCHIP Directors that we will be contacting them by telephone and asking them to participate in the needs assessment.

The second package will include:

• A cover letter from AHRQ contractor explaining the needs assessment (Attachment G1)

• A second copy of the fact sheet describing the needs assessment topics (Attachment F6)

• A Technical Assistance Topics Showcard Packet (Attachment G2)

• A small magnet with the contact information for the project (Attachment G3)

Within two to three days of the second mailing, a member of the team will make telephone contact with agency directors to discuss participation in the needs assessment; to obtain a main contact, as well as contact information for others in the agency or state who should be kept in the loop or who may benefit from the technical assistance activities; and to answer any questions they might have. Project staff will use a semistructured script for these recruitment phone calls (See attachment H)

It is anticipated that the contactors will need to make several calls to each state to identify the appropriate contact person or persons and obtain state approval. Needs assessment site visits will be scheduled on a flow basis, as agencies agree to participate. Following the completed needs assessment, the AHRQ contractor will send a follow up thank you letter (attachment J). Those agencies that refuse the year one assessment will be offered the opportunity to participate in the assessment in the second year.

4. Tests of Procedures

A pilot test of all procedures will be conducted in March 2008. Nine Medicaid and SCHIP Agencies have been selected to participate. The purpose of the pilot test is to test the needs assessment procedures and instruments to ensure the reliability and validity of the measures and the efficiency of the procedures. We plan to conduct the assessment with 6 agencies in-person and with 3 agencies using webex technology. We will also be collecting timing metrics to be able to measure the burden to respondents. The 9 agencies selected represent different levels of health IT and HIE implementation, demographics of the states represented, and whether their Medicaid and SCHIP programs are integrated or if their SCHIP program is administered separately from the Medicaid program. The latter occurs in only 10 states. The 9 agencies provide a fairly representative sample of the rest of the country.

We will prepare and mail via Federal Express, an information packet to invite the 9 selected agencies to participate in the pilot test. The packets will include the following materials:

• A cover letter from AHRQ introducing the project (Attachment F1)

• A cover letter from the AHRQ contractor explaining the project and extending an invitation to take part in the pilot test of the needs assessment (Attachment F7)

• An endorsement letter from NASMD (Attachment F3)

• A one-page “Project Fast Facts” description of the project (Attachment F4)

• A Resource list of publicly available resources for implementing health IT and HIE systems (Attachment F5)

• A fact sheet describing the needs assessment topics (Attachment F6)

The primary purpose of the pilot is to test the Question Guide (attachment C) to ensure the comprehensiveness and suitability of the Question Guide. The results of the pilot test will be used to further refine the Question Guide. Prior to the teleconference interview or on-site visit , the team will gather and pre-populate the Question Guide with whatever relevant information has been collected through literature reviews and reviews of similar recent data collection efforts. The interviewer will ask the respondents to validate the information and then obtain additional/new information about the status of health IT and HIE within the agencies, any on-going projects or initiatives, notable strengths or expertise, challenges, priority areas of concern, and need for consultation and TA within the scope of the project.

5. Statistical Consultants

No statistical analyses beyond descriptive statistics are planned. The information will be used to develop a program of technical assistance but no inferences will be made the universe of agencies.

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